Turkish archives of pediatrics最新文献

Objective: This study aimed to investigate the epidemiological, clinical, laboratory, and radiological characteristics of children diagnosed with Hashimoto's thyroiditis and to present the experiences of a referral center.

Materials and methods: This study included 200 pediatric patients diagnosed with Hashimoto's thyroiditis between January 2020 and May 2024 at a single center. The data were extracted and compiled from the participants' medical records, including clinical information, physical examination findings, laboratory test results, and radiological imaging.

Results: Mean age of the study population was 11.3 ± 3.2 years at diagnosis, with a female predominance. At the time of clinical presentation, 8.5% of the study participants were 6 years of age or younger. The majority of patients, comprising 39.5% of the cohort, exhibited euthyroid thyroid function. Additionally, 33.5% of the patients were classified as having subclinical hypothyroidism, 22% demonstrated overt hypothyroidism, and 5% presented with hyperthyroidism. Approximately one-third of the study participants were referred for further evaluation due to the identification of abnormal thyroid function test results during routine screening examinations. 48% of the patients had a documented family history of thyroid disease. At diagnosis, 39.5% were prepubertal. The rate of overt hypothyroidism was higher in prepubertal patients compared to pubertal patients (41.8% vs. 9.1%, P < .005). Mean gland volume SDS was 2.61 ± 3.69, and 45.5% had goiter. Thyroid nodular lesions were identified in 5.5% of the study participants. Fine-needle aspiration biopsy was performed on five patients, revealing benign findings in three cases and atypia of undetermined significance in the remaining two cases.

Conclusion: Patints with subclinical hypothyroidism who have a baseline TSH level exceeding 8.5 mIU/L at initial presentation and do not receive treatment are likely to progress to overt hypothyroidism during subsequent follow-up. Prepubertal cases were more frequently observed compared to previous reports, and the course of hypothyroidism was more severe in prepubertal patients. These findings suggest a potential shift towards earlier onset of autoimmunity in children. Further studies are warranted to substantiate this observation.

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood.

Materials and methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed.

Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable.

Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers.

Objective: The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital.

Materials and methods: This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital.

Results: Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29).

Conclusion: Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

Vasculitis in children represents a diverse group of diseases characterized by inflammation of blood vessels, which can lead to significant morbidity if not promptly recognized and managed. This review explores the epidemiology, pathophysiology, classification, and management of key pediatric vasculitides. Classification based on vessel size aids in diagnosis and treatment. Understanding these conditions" clinical features and therapeutic options is critical for improving pediatric patient outcomes and preventing long-term complications. Continued research is essential for refining treatment strategies and enhancing patient care.

Objective: The purpose of this study is to compare the surgical outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for pediatric acute appendicitis in order to guide its future management.

Materials and methods: We conducted a retrospective study including all children under the age of 14 years, who underwent appendectomy for acute appendicitis, during a period of 6 years (2013-2018). We divided our patients in two groups based on the surgical modality: the laparoscopic and open group. P values of less than .05 were considered statistically significant.

Results: A total of 690 appendectomies were identified: 151 (22%) were performed laparoscopically and 539 (78%) via laparotomy. The demographic data were comparable between the 2 groups. There was no statistical difference regarding the age, sex. However the frequency of obese patients was higher in laparoscopic approach (P < .001).The mean operative time was significantly longer in the Laparoscopic group (77 ± 39, 6 minutes) compared with Open group (57 ± 27 minutes) (P < .001). Prophylactic drain placement was significantly more common in the open appendectomy group (P = .034). Patients undergoing laparoscopic appendectomy experienced a quicker recovery to apyrexia, reduced use of postoperative analgesics, and postoperative antibiotic compared to those undergoing open appendectomy (P < .05). The mean length of hospital stay was respectively 4 ± 1 day in LA group and 4 ± 2 days in the OA group. No significant difference was observed. The results showed no significant difference between the 2 groups regarding the incidence of wound infection, intra abdominal abscess, intestinal obstruction and umbilical hernia (P > .05).There was no death in this study.

Conclusion: Laparoscopic appendectomy is safe and feasible for the management of appendicitis without significant influence on the complications rate.

Objective: Increased survival rates in childhood cancer have led to an emphasis on the importance of treatment-related infertility. Fertility preservation methods should be explained to every patient and their families (PaFs) before treatment. Establishing good communication with PaFs is crucial in this regard despite many barriers such as cultural and financial barriers. Routine feasibility of sperm preservation (SP) in adolescent males newly diagnosed with cancer was evaluated after the implementation of reimbursement for the procedure and storage by the national healthcare system.

Materials and methods: Males <18 years of age planned to undergo cancer treatment between 2021 and 2023 were included. Patient and their families were informed by the treating physician about the disease, treatment modality, side effects, the importance of SP, and the method. Information about the purpose and technique of SP was provided to the patient alone in a comfortable environment. Questions from PaFs were answered, and consent was obtained. The procedure and storage cost was covered by the social security institution.

Results: Seventeen patients (median age 15) (15 with bone/soft tissue sarcoma, 1 brain tumor, and 1 Hodgkin lymphoma) were included. There were no refusals for SP. Eleven patients were able to provide sperm samples. Of the 6 patients who could not provide sperm, 3 stated embarrassment, 2 anxiety, and 1 cancer-related pain.

Conclusion: Increasing awareness among physicians about the importance of treatment-related infertility, allocating sufficient time to inform PaFs about fertility preservation, and providing information taking into account societal or socio-cultural factors will contribute to preventing treatment-related infertility. Establishing close communication with the Reproductive Health Center (RHC), along with the rapid and cost-free nature of the procedure, enhances success.